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Heroin Addicts Find Benefit In Drug Treatment, But Stigma Lingers

The 50-year-old man wearing a plaid shirt said he struggled with heroin addiction for years. He lost a house and everything else when he was addicted, he said, once selling his truck for drugs.

Things changed when his daughter was born. He was clean at the time and while before he had “no compunction or moral dilemma” about doing drugs, now “something there needed me.”

Then “out of the blue I decided I needed to get high. I just did. I got high, I got institutionalized again, my daughter didn’t have a dad,” the man recalled. With the help of a doctor, he turned to something more medically powerful: buprenorphine, a replacement medication that blocks cravings. “I didn’t have the ability to roll the dice anymore with my kid,” he said. “Now, it’s not even on my radar to get high. It’s something that I’m not ashamed of because I will do what I have to do by any means necessary to not pick up a drug.”

As the man and others attest, buprenorphine can offer a new lease on life for those who have struggled with drug addiction. But using the replacement drug, which is prescribed by a doctor, poses a new set of problems, they say: judgment from the 12-step community, which discourages members from taking drugs of any kind, and from the medical community, which sometimes views them only as drug addicts.

“I get really frustrated when I hear the story of what people go through with 12-step programs and the medical system,” said Dr. Charles Silberstein, a Martha’s Vineyard Hospital psychiatrist who runs a buprenorphine support group. Those taking the drug are not high, he said, and are just like anyone else. “These are the people you meet in real estate offices and doctor’s offices. You have no idea,” he said.

Suboxone and Subutex, the two forms of the drug often used, are prescribed by an eligible doctor and taken once a day, either in the form of a pill or a film placed under the tongue. Candidates for the drug must be committed to living sober lives and cannot be using other drugs heavily, Dr. Silberstein said. If someone takes Suboxone while taking other opiates, he said “they go into intense and severe withdrawal.” Suboxone attaches to the opiate receptor, so other drugs do not have the same effect on the brain. Those on the drug submit to regular urine screens. While Mr. Silberstein said that it is true some sell their medications on the street, the drug can make a difference in the lives of those committed to sobriety.

Dr. Silberstein said that while most Island doctors are understanding, others take a different view. “A lot of people see it as drug addict behavior. But studies show that when [they stop taking Suboxone], old behavior comes back, old cravings come back. What Suboxone allows them to do is not to crave, and it decreases use of other drugs,” the psychiatrist said.

“It’s really tragic that people feel they have to keep it a secret from sponsors, from other people in the 12-step program. Addiction is a disease of secrecy. That people have to keep secrets to join a 12-step meeting or to live with family or to have a sponsor, it really interferes with sober life.”

But there is a place of support for Vineyard residents who take Suboxone or Subutex: a weekly support group led by Dr. Silberstein where about 10 people gather to talk.

The Gazette was invited to attend the support group this week and agreed not to identify any of the group members. While everyone had their own story of addiction and recovery, hopeless times and newfound optimism, there were common threads: each said they are living more productive lives because of Suboxone, which was called a life saver. They emphasized that the drug does not make them feel high, and removes the constant dread of relapsing. Suboxone has saved marriages and allowed them to keep jobs and be better parents, they said. They praised the group and Dr. Silberstein for getting them on track and keeping them sober.

“We’re not like, lowlifes. We’re not the dregs of society,” a 54-year-old mother of two said. “Suboxone is the best thing that ever happened to me.”

“I really believe I was born with this disease,” said a man in a Boston Red Sox hat who moved to the Island about five years ago from central Massachusetts. He struggled with alcoholism and then was in a car accident, which led to an opiate addiction and then heroin. “I know I wouldn’t be sober today without Suboxone,” he said.

But members of the group said they feel shunned at times by other support groups. “I definitely feel, being involved in AA, there is definitely a stigma with the drug,” one man said. “People say, ‘I can always tell people on Suboxone, they are dozing off.’ [But] I know I wouldn’t be clean today — I tried everything.”

The man in the plaid shirt agreed. “It’s not like I got my life back, but kind of like a life I never knew,” he said. “I’m not distracted every moment from wanting to use. It’s no panacea but it’s the best thing that’s come along in terms of addiction for me.” He and others compared 12-step programs to an orthodox religion, where there was no room for a different interpretation of the rules. Others pointed out that when AA was founded, Suboxone did not exist.

“When I was a user my life was pretty bad,” said a woman in her 60s who has been on the Island for 40 years. She said she became an intravenous drug user at age 18.

“I was ready to throw in the towel,” she said. “If this is life I don’t want to be here anymore.” Suboxone gave her a life back, she said, but still she feels judged at times.

“It’s just been really confusing because . . . I got a life back. I don’t want to do heroin again. I don’t feel like that today,” she said.

A 31-year-old woman who is pregnant with her second child and has been sober for nearly six years has continued taking Subutex during her pregnancy. While she was hesitant, it is said to be safe for pregnant women.

She told her prenatal doctors the truth about her medication; she felt that she had nothing to hide. But at every appointment since, she said, her doctors have focused on taking a drug test. Because she hasn’t met her insurance deductible, each one has cost her $600.

“I feel like they just don’t listen to my concerns,” the woman said in a telephone interview. “They are more focused on [the Subutex] than anything else. I’m nervous to give birth here.”

“I know I’m in a good place, my doctors know I’m in a good place, my family knows I’m in a good place,” she said.

She and others praised Dr. Silberstein. “I just owe him everything,” she said. “People need to realize addiction is not a choice, it’s an illness.”

A man who has lived on the Island for nine years said he thinks attitudes are changing about Suboxone. “I think in the future it will be more accepted,” he said.

For his part, Dr. Silberstein said the group is gratifying. “I don’t get paid money but I get paid in lots of other ways,” he said, adding that it’s the most effective medicine for changing lives.

“What I see is that people need less psychiatric medicines, less cravings,” he said. “Everyone in this room is living a sober life; they have homes, are paying taxes.”

“I’m incredibly privileged to work with this group — a really hardworking community of people living sober lives.”

He said things might soon change with the advent of a buprenorphine implant, which works for six months. The implant would “change the argument” because it would eliminate suspicion that patients are selling the drugs.

For some, the road to recovery has not been smooth. “My path is a little bit bumpier,” said a woman wearing a baseball cap. She said she went through numerous rehabs and was a little more than four years clean at one point, but relapsed.

After she got married and had her first child, she said, she learned that addiction was “stronger than the bonds of motherhood” and turned to Suboxone.

She has had relapses with alcohol, marijuana and other drugs. “That said, in the past, without Suboxone any one of those [relapses] would have led me down a slippery slope toward total disaster,” she said.

But with the medication, support from the group and Dr. Silberstein, she said, as well as urine screens, “I don’t have to snowball into losing my kids.”

She added: “None of us are high. The idea that Suboxone gets people high, it’s just not true. It’s a brain chemistry problem with a brain chemistry solution. We’re all living proof of that.”